Pilonidal disease is an inflammatory disease associated with the formation of cysts or fistulas in the area of the intergluteal cleft. It usually develops in young Caucasian men with excessive hair growth over the body, but it is also possible in women. One or more spots or depressions are defined on the skin in the sacral region at or near the midline; a cavity containing hair may be formed. Symptoms are usually absent; if infection occurs, pain occurs, and surgical intervention may be required. The disease is more common in adolescents and young adults, especially those with sedentary lifestyles. The incidence is reported to be between 26 and 100 cases per 100,000 people per year, with a high risk of recurrence (up to 33%, especially in the first year after treatment) [1].

Classical approaches include hair removal in the affected area using special creams or mechanical depilation, hygiene maintenance, and, in complicated cases, surgical treatment. Postoperative therapy aims to reduce the risk of recurrence, but recurrent inflammation remains a frequent problem [1].

Recently, laser hair removal has been recognized as an effective way to prevent recurrences. This method aims to destroy hair follicles, which are crucial in developing the disease. Hair ingrowth creates favorable conditions for infection and inflammation. Eliminating this cause can significantly reduce the risk of recurrence [2].

In a study conducted in the United States, 302 patients aged 11 to 21 participated [3]. The participants were divided into two groups: the first group received standard treatment with the addition of laser hair removal, and the second (control) group received standard treatment only.

The standard treatment regimen was based on published studies and guidelines and included recommendations for improved hygiene and permanent mechanical or chemical depilation of the intergluteal hair. Participants in the control group received general information about the disease and hair removal. They were advised to perform chemical (applying cream as directed) or mechanical depilation (shaving) to maintain a hair-free zone. For this purpose, they were given epilation supplies for 6 months with the recommendation to continue regular hair removal until the patient reached the age of 30 years. As desired, the patient and family could also schedule additional in-person visits for further education and training.

Laser therapy included a treatment every 4–6 weeks for 5 treatments. The choice of laser device was based on the patient's skin phototype: 810-nm diode (for Fitzpatrick phototypes I–IV) or 1064-nm Nd:YAG (for skin phototypes V–VI). As in the control group, patients and family members were taught hair removal techniques at the first visit and were asked to perform chemical or mechanical depilation as needed to maintain a hair-free zone between laser treatments.

After one year, only 10.4% of patients in the first group had recurrences, compared to 33.6% in the second (control) group. These results confirm that laser hair removal significantly reduces the likelihood of recurrence.

Laser hair removal has proven safe and effective in preventing pilonidal recurrence. This approach is essential for younger patients, helping them avoid reoperations and improve their quality of life. Increased access to this technology may significantly change the approach to treating this disease.

References

1. Gil L.A., Deans K.J., Minneci P.C. Management of Pilonidal Disease: A Review. JAMA Surg 2023; 158(8): 875–883.
2. Mei Z., Zheng D., Wang Q. Analysis of the Laser Epilation in Pilonidal Disease Trial. JAMA Surg. 2024; 159(6): 721–722.
3. Minneci P.C., Gil L.A., Cooper J.N. et al. Laser epilation as an adjunct to standard care in reducing pilonidal disease recurrence in adolescents and young adults: a randomized clinical trial. JAMA Surg. 2024; 159(1): 19–27.